Nicole Derosa, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

ND8682 Issued in FL

Practice address

1210 E Plant St Ste 130
Winter Garden, FL 34787-2995

Phone

(407) 297-8408

NPI assigned

Feb 13, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• West Orange Winter Garden Dialysis Center, LLC

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Winter Garden, FL
  • NPI 1174902779
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550016000000",
    "number": "1144786252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "249 ALFORD DR",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338968396",
            "telephone_number": "203-560-4039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 E PLANT ST STE 130",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347872995",
            "telephone_number": "407-297-8408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEROSA",
        "first_name": "NICOLE",
        "credential": "RD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-02-13",
        "last_updated": "2019-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dietitian, Registered",
            "state": "FL",
            "license": "ND8682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMISSION OF DIETETIC REGISTRATION",
            "identifier": "86077693",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FLORIDA DEPARTMENT OF HEALTH",
            "identifier": "ND8682",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda J Degee, APRN, PMHNP-BC
• Delaney K Leonard
• Shannon Delong, PA-C
• Camille Denefield
• Diana Nicole Dennis, FNP-C
• Karan A Desai, M.D.
• Paul Ulrick Desir
• Jenny Desravines, NP
• Yralia Devereux
• Carmen Xiomara Devia, MS

• Registered Dietitian in Winter Garden, FL
• Providers in Winter Garden, FL by specialty
• Registered Dietitian in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.